Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Abstract

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction

“…An area of critical importance is to safeguard the use of antimicrobials and to focus on appropriate and targeted antimicrobial use in humans, animals and the environment [ 20 , 21 ]. This is the strategy behind the World Health Organizations’ One Health approach [ 22 , 23 ].…”

“…This includes Kazakhstan where multiple strategies helped reduce inpatient antibiotic utilization from 12.72 DIDs (DDDs/1000 inhabitants/day) in 2011 to 2.74 in 2018 [ 10 ] and Slovenia where multiple strategies reduced overall antibiotic utilization by 31% between 1999 and 2012 [ 24 ]. However, in Poland, the lack of multiple coordinated activities resulted in a small but statistically significant annual increase in total antibiotic consumption from 22.2 DIDs to 23.9 DIDs between 2007 and 2016 [ 21 , 27 ].…”

“…Developing countries, also referred to as LMICs, are implicated in the inappropriate prescribing of medicines in healthcare settings including antimicrobials for essential viral infections [ 21 , 34 , 35 ]. The current dilemma regarding AMR is due to the overuse and inappropriate use of antimicrobials, which includes inappropriate selection and dosing by HCPs, and non-adherence to treatment guidelines including among HCPs in South Africa [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

“…The WHO in collaboration with the International Network for Rational Use of Drugs recommend proper documentation of medicine use, applying core indicators (34). However, there are concerns whether these actually measure the quality of antimicrobial prescribing in ambulatory care, with reference to better clinical outcomes [ 21 , 36 ].…”

“…Currently, there is a paucity of scientific data pertaining to the African region on the quality of antimicrobial use at the PHC level, including adherence to prescribing guidelines which is considered a good indicator of the quality of prescribing [ 21 , 38 , 39 , 42 , 43 ]. Consolidating programmes and initiatives including antimicrobial stewardship (AMS) across health sectors is necessary to address AMR [ 44 , 45 , 46 ].…”